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JAMA Surg. 2015 Jun;150(6):512-8. doi: 10.1001/jamasurg.2014.3852.

Short-term Results of a Magnetic Resonance Imaging-Based Swedish Screening Program for Individuals at Risk for Pancreatic Cancer.

Author information

1
Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
2
Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
3
Division of Radiology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
4
Department of Clinical Genetics, Karolinska Institute, Stockholm, Sweden.
5
Department of Onco-Pathology, Karolinska Institute, Stockholm, Sweden.
6
Department of Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.

Abstract

IMPORTANCE:

Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries. In approximately 10% of all patients with pancreatic cancer, it is possible to define a positive family history for pancreatic cancer or for one of the other related genetic syndromes. A screening program for individuals at risk is recommended; however, surveillance modalities have not been defined yet.

OBJECTIVE:

To analyze the short-term results of a prospective clinical surveillance program for individuals at risk for pancreatic cancer using a noninvasive magnetic resonance imaging (MRI)-based screening protocol.

DESIGN, SETTING AND PARTICIPANTS:

A prospective observational study of all patients with a genetic risk for developing pancreatic cancer who were referred to Karolinska University Hospital between January 1, 2010, and January 31, 2013, using an MRI-based surveillance program. All patients were investigated for the most common genetic mutations associated with pancreatic cancer.

EXPOSURE:

A noninvasive MRI-based screening protocol.

MAIN OUTCOMES AND MEASURES:

The ability of MRI to identify potential precancerous or early cancers in individuals at risk for pancreatic cancer.

RESULTS:

Forty patients (24 women and 16 men) were enrolled. The mean age was 49.9 years. The mean length of follow-up was 12.9 months. The numbers of relatives affected by pancreatic cancer were 5 in 2 patients (5%), 4 in 5 patients (12.5%), 3 in 17 patients (42.5%), 2 in 14 patients (35%), and 1 in 2 patients (5%). In 4 patients (10%), a p16 mutation was found; in 3, a BRCA2 mutation (7.5%); and in 1, a BRCA1 mutation (2.5%). In 16 patients (40%), MRI revealed a pancreatic lesion: intraductal papillary mucinous neoplasia (14 patients, 35%) and pancreatic ductal adenocarcinoma (2 patients, 5%). One patient had a synchronous intraductal papillary mucinous neoplasia and pancreatic ductal adenocarcinoma. Five patients (12.5%) required surgery (3 for pancreatic ductal adenocarcinoma and 2 for intraductal papillary mucinous neoplasia), while the remaining 35 are under continued surveillance.

CONCLUSIONS AND RELEVANCE:

During a median follow-up of approximately 1 year, pancreatic lesions were detected in 40% of the patients, of whom 5 underwent surgery. Although the study time was relatively short, the surveillance program in individuals at risk seems to be effective.

PMID:
25853369
DOI:
10.1001/jamasurg.2014.3852
[Indexed for MEDLINE]

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